双语阅读:当医疗资源不足时,拯救谁?放弃谁?
网友【english】于【太平洋时间 2020-03-27 09:41:45】分享在【美国信息交流】版块    18015    2    5

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所有人都在关注这场疫情,

所有人也应该保持头脑清醒。

每天围绕疫情的一个剖面,

与各行各业有信息素养的人一起,

为你马克最值得一读的新闻报道和深度分析。

意大利、日本和美国的疫情都在加重,当地的医疗资源面临极度紧缺的情形。当医疗资源不足时,该怎么决定拯救谁,以及又由谁来决定?今天推荐的《纽约时报》文章,从历史上的其他流行病以及过往政策上来讨论这个问题。

在 2012 年,飓风袭击纽约的时候,当地的医院就曾经面临这种困境;而在这次疫情中,如今很多地方的医院也同样面临这种困境。有专家提倡按照纯粹的年龄和健康状况来筛选,谁最有可能存活时间就先拯救谁;也有人赞成单纯的抽签,不管怎样,大家一致认为肤色、身份、社会价值、民族背景等不应该影响到最终的决策。

另外,专家号召应该由专门的团队来做这种决定,而不能让前线的医生背负这种压力。而对于病人和家属的知情权,文章也有讨论。

事实上,在意大利的一些医院,因为 ICU 数量不够,很多医生正面临着这种生死抉择,而且当地的医疗组织也提供了一些选择建议:给接受重症监护治疗的病人设置年龄限制。「丁香园」的文章详细讨论了年龄限制是否合理,可以跟本文一起配合阅读。

丁香园:为转入 ICU 的患者设置年龄限制,这样公平吗?

文章和图片版权来自《纽约时报》,轻芒杂志经《纽约时报》授权翻译发布。

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劳拉·埃文斯博士站在在西雅图华盛顿大学医学中心门口,她在这里负责对冠状病毒的应对工作。

The medical director of the intensive care unit had to choose which patients’ lives would be supported by ventilators and other equipment. Hurricane Sandy was bearing down on Bellevue Hospital in New York City in 2012, and the main generators were about to fail. Dr. Laura Evans would be left with only six power outlets for the unit’s 50 patients.

在某些情况下,重症监护室的医疗主管必须做出选择,决定哪些病人的生命可以得到呼吸机和其他设备的维持。2012 年,飓风「桑迪」袭击纽约市贝尔维尤医院,主发电机即将失灵。劳拉·埃文斯医生只剩下 6 个电源插座可用,而重症监护室内却有 50 名病人。

Hospital officials asked her to decide which ones would get the lifesaving resources. “Laura,” one official said, “we need a list.” After gathering other professionals, Evans checked off the names of the lucky few.

医院官员把救命资源分配的决定权交给了埃文斯。一名官员说:「劳拉,请给我们一份名单。」在与其他专业人士讨论后,埃文斯勾选出少数幸运者。

Now she and doctors at hospitals across the country may have to make similarly wrenching decisions about rationing on a far bigger scale. Epidemic experts predict an explosive growth in the number of critically ill patients, combined with severe shortages of equipment, supplies, staffing and hospital beds in areas of the U.S. where coronavirus infections are surging — hot spots that include New York, California and Washington state.

疫情当前,全美各大医院的医生可能会像当年的埃文斯一样,被迫做出痛苦的抉择,为更多的病人配给医疗资源。流行病学专家预测,在纽约州、加州和华盛顿州等新冠病毒感染人数激增的疫情重大灾区,危重病人数量将出现爆炸性增长,而医疗设备、物资、医护人员和病床将严重短缺。

Health workers are urging efforts to suppress the outbreak and expand medical capacity so that rationing will be unnecessary. But if forced, they ask, how do they make the least terrible decision? How do they minimize deaths? Who even gets to decide, and how are their choices justified to the public?

医护人员敦促尽力抑制疫情爆发并增强医疗能力,以避免实行配给制。同时,医护人员也想知道,如果不得已而为之,在做决定时,如何把危害降到最低?如何尽可能减少死亡人数?他们甚至需要去做决定,怎样的选择对公众来说才算合理?

Medical providers are considering these questions based on what first occurred in China, where many sick patients were initially turned away from hospitals, and now is unfolding in Italy, where overwhelmed doctors are withholding ventilators from older, sicker adults so they can go to younger, healthier patients.

考虑到中国最先发生和意大利随后出现的情况,医疗设备供应商也在思考这些问题。此前新冠病毒首先在中国爆发,刚开始的时候,很多病人被医院拒之门外。而现在,在意大利,不堪重负的医生撤下了年龄较大、病情较重的成年人的呼吸机,让给更年轻、症状较轻的病人使用。

Choosing between patients “goes against the way we used to think about our profession, against the way we think about our behavior with patients,” said Dr. Marco Metra, chief of cardiology at a hospital in one of Italy’s hardest-hit regions.

在病人之中做出选择,「与我们对自己职业的看法相悖,也有悖于我们考虑的对待病人的方式,」心脏病学主任医师马尔科·马特拉说,他所在的医院位于意大利疫情最严重的一个地区。

In the United States, some guidelines already exist for this grim task. In an effort little known even among doctors, federal grant programs helped hospitals, states and the Veterans Health Administration develop what are essentially rationing plans for a severe pandemic. Now those plans, some of which may be outdated, are being revisited for the coronavirus outbreak.

其实美国有现成的指导原则,说明如何执行这项严酷的任务。曾经,在联邦政府补助项目的帮助下,几家医院、几个州和美国退伍军人健康管理局制定了一些规则,其实质是针对严重疫情大流行的配给方案,这些连医生都很少知道。虽然部分方案可能已经过时,但目前正在重新讨论修改,以期用于新冠病毒疫情。

But little research has been done to see whether the strategies would save more lives or years of life compared with a random lottery to assign ventilators or critical care beds — an option some support to avoid bias against people with disabilities and others.

不过,很少有研究显示,以上策略跟随机抽签分配呼吸机和重症护理床的模式相比,是否能拯救更多的生命或更多最有可能活更长时间的人?有人对抽签表示支持,因为能避免对残疾人等病人产生偏见。

Some commonly recommended rationing strategies, researchers found, could paradoxically increase the number of deaths. And protocols involve value judgments as much as medical ones and have to take into account the public’s trust.

研究人员发现,如果采用普遍推荐的配给策略,可能反而会增加死亡人数。在制定医疗方案时,一旦涉及与医疗判断同样重要的价值判断,就必须把公众信任考虑在内。

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人们在布鲁克林医院中心外排队接受冠状病毒检测。在美国,纽约是疫情重灾区。

If hospitals withhold treatment by age, where do they draw the line? If they give lower priority to those with certain underlying health conditions, they may in effect be offering black Americans less treatment than white Americans. If physicians try to redirect resources — putting a patient on a ventilator for a few days, then giving it to someone else who appears to have better prospects — more people may die because few would get adequate treatment. And if many patients have a similar chance of survival, what fair way is there to make a choice?

如果医院因为年龄大而放弃治疗,那么该如何划定界限呢?如果医院给予那些有潜在健康问题的患者更低优先级,那么非洲裔美国人实际上可能比美国白人获得更少治疗。如果医生尝试重新分配资源——让一位病人使用几天的呼吸机,再把这台仪器转给另一名看起来更容易好的病人使用——可能更多人会因此而去世,因为几乎没有人得到了充分的治疗。如果很多病人的存活几率都差不多,那么如何选择才算公平呢?

The federal government — so far, at least — is not providing national rationing guidelines for the coronavirus outbreak. Officials from various states, medical associations and hospitals are discussing their own plans, potentially resulting in very different decisions on life-and-death matters about which there are deep disagreements, even among medical professionals.

无论如何,联邦政府迄今为止都没有规定统一的指导原则,用于新冠病毒爆发期间的全国配给。各州、医疗协会及医院的官员正在讨论各自的方案,针对此生死攸关的问题,可能会产生大相径庭的决策;大家对这个问题的看法也存在较大的分歧,即使是医疗专业人员也如此。

“You have to be really clear about what you are trying to achieve,” said Christina Pagel, a British researcher who studied the problem during the 2009 H1N1 flu pandemic. “Maybe you end up saving more people, but at the end you have got a society at war with itself. Some people are going to be told they don’t matter enough.”

「你必须非常明确设法达成的目标是什么,」英国研究人员克里斯蒂娜·帕格尔说;她曾经研究过 2009 年 H1N1 流感大流行期间的配给问题。「可能到头来你拯救了更多的人,但最终会引起社会各界的纷争。一些人会得知,他们不够重要。」

‘The Most Good’

「尽可能提供帮助」

Just before the coronavirus outbreak, Evans, the physician at Bellevue, moved across the country to direct the intensive care unit at the University of Washington Medical Center in Seattle. The city became one of the first areas in the United States to see community spread of the virus.

就在新冠病毒爆发之前,贝尔维尤医院的埃文斯医生横跨美国,从纽约搬迁至西雅图,成为了华盛顿大学医学中心重症监护室主管。西雅图是美国首批发现病毒在社区蔓延的地区之一。

The hospital is doing whatever it can to prevent the need to ration — what Evans referred to as “an ethical obligation.” Like other institutions, it is trying to increase supplies, training staff to act in roles that may be outside their usual jobs and postponing elective surgeries to free up space for coronavirus patients. Some cities are racing to construct new hospitals.

医学中心正在全力以赴,避免配给;埃文斯把配给称之为「一种伦理责任」。医学中心也跟其他医院一样,想方设法增加物资,培训员工在日常工作之外履行更多职责,并推迟选择性手术,以腾出更多空间治疗新冠肺炎患者。一些城市也在争先恐后地兴建医院。

Strategies to avoid rationing during the pandemic were published by the National Academy of Medicine. But hospitals across the country vary in their adherence to such steps. At the University of Miami’s flagship hospital, surgeons were told last Monday to cancel elective surgeries, but across the street at Jackson Memorial Hospital, they were “given wide discretion over whether to cancel or proceed,” according to an update sent to physicians.

尽管美国国家医学科学院已经发布了疫情大流行期间避免使用配给制的策略,但全美医院在实际执行时却各有差异。3 月 9 日,迈阿密大学旗舰医院的医生接到通知,取消选择性手术;而马路对面的杰克逊纪念医院,医生收到的更新信息则是:「授予了较大的权限,可酌情决定是否取消或继续实施选择性手术。」

Evans is working with health leaders in Washington state to figure out how to implement triage plans. Their goal, she said, would be “doing the most good for the most people and being fair and equitable and transparent in the process.”

目前,埃文斯正在与华盛顿州的卫生领导合作,以明确如何实施患者鉴别分类方案。她指出,目标是「尽可能帮助绝大多数人,同时在整个过程中保持公平、公正与透明度。」

But guidance endorsed and distributed by the Washington State Health Department last week suggested that triage teams under crisis conditions should consider transferring patients out of the hospital or to palliative care if their baseline functioning was marked by “loss of reserves in energy, physical ability, cognition and general health.”

但上上周华盛顿州卫生部签署并发布的指导原则建议,如果病人的基本功能出现了以下特征:「精力、体能、认知能力以及总体健康状况的储备能力丧失」,那么患者鉴别分类团队应考虑将这些重症病人转移出医院或实施缓和医疗。

The concept of triage stems from Napoleon’s battlefields. The French military leader’s chief surgeon, Baron Dominique Jean Larrey, concluded that medics should attend to the most dangerously wounded first, without regard to rank or distinction. Later, doctors added other criteria to mass-casualty triage, including how likely someone was to survive treatment or how long it would take to care for them.

患者鉴别分类的概念源自于法国军事领袖拿破仑的战场。拿破仑的主任医师多米尼克·珍·拉瑞男爵断定,军医应首先护理伤势最危重的病人,无论军衔或等级。后来,医生为大规模伤亡患者鉴别分类陆续加入了更多标准,包括病人在治疗过程中存活的可能性或护理病人的时间长短。

Protocols for rationing critical care and ventilators in a pandemic had their beginning during the anthrax mailings after the Sept. 11 attacks but have not previously been implemented.

疫情大流行期间的重症护理和呼吸机配给方案,始于 911 恐怖袭击后的炭疽邮件事件,但这些方案之前从未实施过。

Dr. Frederick Burkle, a former Vietnam War physician, laid out ideas for how to handle the victims of a large-scale bioterrorist event. After the SARS outbreak stressed Toronto hospitals in 2003, some of his ideas were proposed by Canadian doctors, and they made their way into many American plans after the H1N1 pandemic in 2009. “I have said to my wife, ‘I think I developed a monster here,’” Burkle said in an interview.

如何为大规模生物恐怖主义事件的受害者制定配给方案,前越南战争军医弗雷德里克·博克勒曾经解释过。2003 年非典爆发后,加拿大多伦多的医院压力陡增,那里的医生提议借鉴博克勒的想法;这些医生也在 2009 年 H1N1 流感大流行后参考了很多美国方案。「我已经跟妻子说了,『我认为自己在这里制造了一个怪物,』」博克勒在一次采访中称。

What worried him was that the protocols often had rigid exclusion criteria for ventilators or even hospital admission. Some used age as a cutoff or preexisting conditions like advanced cancer, kidney failure or severe neurological impairment. Burkle, though, had emphasized the importance of reassessing the level of resources sometimes on a daily or hourly basis in an effort to minimize the need to deny care.

博克勒最担心的是,对于呼吸机的使用、甚至是入院要求,这些方案往往设定了严格的排除标准。一些方案把年龄或癌症晚期、肾衰竭和严重的神经功能缺损等既往病史作为排除条件。尽管如此,博克勒强调,最重要的是,有时需每日或每小时重新评估资源水平,以尽可能为更多人提供护理。

Also, the plans might not achieve their goals of maximizing survival. For example, most called for reassigning a ventilator after several days if a patient was not improving, allowing it to be allocated to a different patient.

同时,这些方案或许无法达到挽救最多生命的目标。例如,绝大多数方案要求,如果一名病人在使用呼吸机治疗几天后没有起色,就应重新分配仪器、转给其他患者使用。

But rapidly cycling ventilators might not give anyone enough chance to improve. When the coronavirus causes severe pneumonia, doctors are finding that patients require treatment for weeks.

但如此迅速地轮换呼吸机,也许任何一个病人都没有足够的机会好转。而医生发现,对于新型冠状病毒引发的严重肺炎,往往需要几周的时间来治疗。

In Canada, a study of H1N1 patients found that 70% of those who would have been withdrawn from ventilators after a five-day time trial if a rationing plan had been implemented actually survived with continued care.

在加拿大,一项针对 H1N1 病人的研究发现,70% 的患者经过持续护理存活了下来;但如果实施了配给方案,在 5 天的尝试后撤下呼吸机,就不会有那么多幸存者了。

Researchers at a British hospital had similar findings, concluding that “a new model of triage needs to be developed.”

英国一家医院的研究人员也得出了类似的结论,称「需要开发患者鉴别分类的新模式」。

A Score Card and a Lottery

记分卡与撞大运

Many of the original plans in the U.S. were developed exclusively by medical personnel. But in Seattle, public health officials gathered community input on a possible plan more than a decade ago.

在美国,很多方案最初仅由医疗人员制定。但在西雅图,早在十多年前,公共卫生官员就把社区建议整合到可能的方案中。

Some citizens feared that using predicted survival to determine access to resources — a common strategy — might be inherently discriminatory, according to a report on the exercise. Citing “institutional racism in the health care system,” they were concerned that the metrics for some groups, like African Americans and immigrants, would be skewed because they had not received the same quality of care.

有报告指出,一些公民担心,在配给中,普遍采用预测的存活几率来决定资源的使用权,可能存在固有的歧视性。他们引用了「医疗体系的制度性种族主义」,担心对非裔美国人和移民等一些群体的度量标准可能会有失偏颇,因为这些人从未接受过同等质量的护理。

There were similar findings in Maryland, where researchers at Johns Hopkins engaged residents across the state in deliberations over several years.

在马里兰州,约翰斯·霍普金斯大学的研究人员邀请本州居民参与了多年的讨论后,也得出了类似的结论。

The researchers presented them with several options. Hospitals could assign ventilators on a first-come, first-served basis. Some thought that could disadvantage people who lived far from hospitals. A lottery struck other participants as more fair.

研究人员向这些居民提出了几个备选方案,让他们各抒己见。一些参与者认为,医院采用先到先得的原则来分配呼吸机,不利于住所离医院较远的居民。另一些则赞同抽签分配,认为此举更公平。

Others argued for a more outcome-oriented approach. One goal could be saving the highest number of lives, regardless of factors like age. A different goal could be saving the most years of life, a strategy favoring younger, healthier patients. Participants also considered whether those playing a valuable role in a pandemic, like medical workers who risked their lives, should be made a priority.

还有参与者对更加以结果为导向的方法表示支持。目标或许可以设定为拯救最多的生命,而不考虑年龄等因素;也可以设定为拯救那些最有可能活更长时间的人,也就是对更年轻、更健康的病人有利的政策。参与者也考虑了在大流行期间起到重要作用的因素:例如,冒着生命危险的医务人员,如果患病,就应优先救治。

After the project ended, the Hopkins researchers designed a framework that assigns scores to patients based on estimated probability of short- and long-term survival. The latter was defined by whether the person had a pre-existing life expectancy of at least a year. Ventilators would be provided, as available, according to their ranking. The framework recommends a lottery for lifesaving resources when patients have identical scores. Stage of life may also be used as a “tiebreaker.” Decisions should be made by designated triage officers, not individual doctors caring for patients, and there should be a limited appeals process in cases of resource withdrawal, the protocol said.

项目结束时,霍普金斯的研究人员设计了一个框架。在该框架中,根据估计的短期和长期存活的可能性,为病人打分。长期存活的可能性界定如下:病人是否有至少一年的预期寿命。呼吸机会根据这些人的评分高低来提供。该框架建议,如果病人的得分相同,则采用抽签的方式来分配救生资源。处于生命的何种阶段也应作为「决胜因素」。该方案称,做决策的应当是指定的患者鉴别分类官员,而不是负责护理病人的医生;在撤掉资源的情况下,还应提供有限的申诉程序。

The public input led the Hopkins researchers not to incorporate most exclusion criteria.

接受公众建议后,霍普金斯的研究人员没有采纳大部分排除标准。

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约翰斯·霍普金斯大学的李·多尔蒂·比迪生医生,她帮助制定了一个分配指导原则,供医院在危急时刻参考。

Dr. Lee Daugherty Biddison, one of the effort’s leaders, said that was because most participants were uncomfortable excluding patients with underlying health issues. Preconditions don’t always predict survival from respiratory viruses, and having chronic diseases like diabetes, kidney failure and high blood pressure often tracks with access to medical care. Rationing based on these conditions would be “essentially punishing people for their station in life,” Biddison said.

以上研究的主管之一李·多尔蒂·比迪生称,之所以没有纳入,是因为绝大多数参与者在排除拥有潜在健康问题的病人时感到不安。既往病史并不总是预测感染呼吸道病毒后幸存几率的唯一因素,糖尿病、肾衰竭和高血压等慢性病患者也经常被发现获得医疗护理。基于这些条件的配给,「其实质是在惩罚身体状况不佳的病人,」比迪生说。

The Hopkins group published a description of the framework last year, and doctors from other Maryland hospitals are teleconferencing twice a day to prepare to implement the plan if conditions grow extreme. Biddison has also been sharing the recommendations with doctors across the country.

去年,霍普金斯研究团队发布了框架说明,马里兰州其他医院的医生一天开了两次电话会议,准备在极端条件下实施方案。比迪生也与全美的医生分享了以上建议。

In Pennsylvania, Dr. Douglas White, chairman of ethics in critical care medicine at the University of Pittsburgh School of Medicine, is using the Hopkins protocol to help prepare hospitals in his state.

在宾西法尼亚州,道格拉斯·怀特医生正在使用霍普金斯方案帮助本州医院做好准备;怀特是匹兹堡大学医学院重症护理医学中心的伦理主席。

In Colorado, Dr. Matthew Wynia, a bioethicist and infectious disease doctor, is working on a plan that would also assign a score. In his rubric, the first considerations are odds of survival and expected length of treatment. He said there was wide agreement among planners “not to make decisions on perceived social worth, race, ethnic background and long-term disability status,” which some fear could happen if doctors had to make seat-of-the-pants judgments without guidelines.

在科罗拉多州,生物伦理学家、传染病医生马修·怀尼亚也在制定一项评分方案,其中首要考虑的因素是存活的几率和治疗的预期时长。他说,方案制定者普遍同意,「不能根据察觉到的社会价值、种族、民族背景和长期的残疾状态来做决定」。一些人还是担心,如果医生在缺乏指导原则的情况下凭感觉判断,这种事情还是有可能发生。

He is also trying to ensure that patients on admission to Colorado hospitals are asked whether they would forgo a ventilator if there were not enough for everyone. “One thing everyone agrees on is that the most morally defensible way to decide would be to ask the patients,” Wynia said.

怀尼亚也尽量保证科罗拉多州各家医院在接收病人入院时,会问他们一个问题:如果呼吸机不够用,是否会放弃使用这种设备。「大家都赞同的一点是,从道德上讲最合乎情理的决策方式,是征求病人的意见,」怀尼亚称。

He supports the idea of reassigning ventilators in certain cases. “If things are clearly getting worse, it’s really hard to justify a stance of once you’re on a vent, you own it, no matter how many people have to die in the meantime,” Wynia said.

怀尼亚支持在某些情况下重新分配呼吸机的理念。「如果局势明显变得越来越糟,的确很难证明立场是合理的——一旦给你上了呼吸机,你就拥有了使用权,不管同时有多少人不得不因此而死去,」怀尼亚说。

Unlike in Italy, where age has been used in rationing treatment, some people developing protocols elsewhere have de-emphasized it. “There are arguments about valuing the young over the old that I am personally very uncomfortable with,” Pagel, the British researcher, said, including that young people should be a higher priority because they have more life ahead of them.

在意大利,年龄已经成为了配给治疗的指标,而其他地区不一样,一些方案制定者已经不再重视年龄因素。「有人认为年轻人比老年人更有价值,我个人对此感到很气愤,」英国研究人员帕格尔称;同样惹恼她的,是年轻人应该有较高的优先级,因为他们今后比老年人活的时间更长。

“Where is your threshold? Is a 20-year-old really more valuable than a 50-year-old, or are 50-year-olds actually more useful for your economy because they have experience and skills that 20-year-olds don’t have?”

「你设定的门槛是什么?20 岁的年轻人真的比 50 岁的老人更有价值吗?还是说,50 岁实际上对你的经济更有用,因为他们已经积累了 20 岁所没有的经验和技能?」

网友分享在meiguo.com上的图片
巴尔的摩地区的免下车检疫点。

A Right to Know

知情权

As Hurricane Sandy intensified outside Bellevue in 2012, Evans referred to New York state guidelines, since updated — which some hospital leaders have said they will follow if overwhelmed by the coronavirus — on how to allocate ventilators in a pandemic using a scoring system that tries to estimate someone’s chance of survival. She pulled together an ad hoc committee of doctors, ethicists and nurses. “Having a system and procedures gave us a sense we had some control of the situation,” she recalled.

2012 年,贝尔维尤医院外的飓风「桑迪」越刮越猛,医院内的埃文斯查阅了纽约州指导原则,发现在疫情大流行期间,可通过评分系统估计病人的存活几率来分配呼吸机;那时候,一些医院的领导称,如果新冠病毒使医院不堪重负,他们也只有被迫遵循这套指导原则。当时,埃文斯成立了由医生、伦理学家和护士组成的临时委员会来做决定。「在这套体系和规程的指导下,我们获得了判断力,对局势有了一定掌控,」她回忆道。

For those about to lose electricity, she and her colleagues stationed two staff members at the bedside of all patients who relied on ventilators, preparing to manually squeeze oxygen into their lungs with flexible Ambu bags.

针对呼吸机即将断电的所有病人,埃文斯和同事安排了两名员工在患者的床边,准备好使用便携式加压给氧气囊,手动挤压氧气到病人肺部。

Looking back, Evans feels the patients and their families had the right to know that their machines would lose power, but in the crisis they hadn’t been told. The doctors also did not think to ask whether any patients or their families might volunteer to give up a power outlet so that it could be provided to someone else. “It wasn’t even on my radar,” Evans said.

回首往事,埃文斯感到病人及其家属有权知道当时发生了什么:仪器即将断电,但由于事发突然,情况紧急,没来得及通知。医生当时也没想到询问任何病人或家属,有没有可能自愿放弃插座,让给他人使用。「我根本就没有意识到可以这样问,」埃文斯称。

In the end, it was improvisation that prevented tragic rationing at Bellevue. The generator fuel pumps failed, but a chain of volunteers hand-carried diesel up 13 flights of stairs. Evans’ patients were all maintained on backup power until they were transferred to other hospitals.

最终,团队临时想出的应对办法避免了在表维医院发生悲剧性的配给。发电机的燃油泵出现了故障,但一波又一波的志愿者手提柴油机,送上了 13 楼。埃文斯每一位病人的生命都靠备用电源得以维持,直到转移至其他医院。

“I remember it really vividly,” she said of the experience. “It’s going to stay with me my entire professional career.”

「一切都历历在目,」谈到这段经历时,埃文斯如是说。「它将伴随我整个职业生涯。」

原文标题:The Hardest Questions Doctors May Face: Who Will Be Saved? Who Won’t?
原文作者:Sheri Fink
翻译:熊猫译社 夏晴
©2020 The New York Times Company

整理:轻芒杂志(微信订阅号:qingmangzazhi

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